Attribunal processes concerning medication taking and their subsequent effects on fear reduction during exposure-based treatment

Abstract

The primary aim of the current study was to investigate the effects of attributions on fear reduction by having participants undergo exposurebased treatment in the context of an inactive medication that they were led to believe made the exposures easier (informed that the medication had a relaxing/sedating side-effect profile) or made the exposures more difficult (informed that the medication had an activating side-effect profile). Participants (N = 95) displaying marked claustrophobic fear were randomly assigned to 1 of 6 conditions: (a) Exposure Only (EO), (b) Exposure + Pill Placebo + Arousal Instruction (EPA attribution for pill interference), (c) Exposure + Pill Placebo + Neutral Instruction (EPN), (d) Exposure + Pill Placebo + Relaxation Instruction (EPR attribution for pill facilitation), (e) credible psychological placebo treatment (PLT), or (f) wait-list (WL). Consistent with prediction, results showed that an attribution for pill facilitation (EPR: relaxing/sedating instruction) interfered with fear reduction and led to higher relapse. Contrary to prediction, an attribution for pill interference (EPA: arousal instruction) did not outperform the other exposure conditions. Clinically significant improvement rates at posttreatment were as follows: EO = 73%, EPA = 75%, EPN = 78%, EPR = 76%, PLT = 60%, WL = 10%. Clinically significant improvement rates at follow-up were as follows: EO = 87%, EPA = 85%, EPN = 89%, EPR = 53%, PLT = 40%, WL = 30%. Relapse rates at follow-up were as follows: EO=0%, EPA=0%, EPN=0%, and EPR=39%. The deleterious effects of the relaxation instructions were fully mediated by attributions about the helpful effects of the medication reducing the variance accounted for by treatment from 30% to 7%. Findings suggest the importance of assessing attributions during combined exposure-based and pharmacological treatments and attention to a slow medication taper and reapplication of exposure during the taper.